He had some heart conditions, which made us
worry about the risk of him suddenly dying.
It's mind-boggling, really,
that somebody is willing to place their life in your hands.
These poor patients are waiting and waiting, and you keep thinking
"If that was me, if that was my mum, that's not fair."
I've had a scan. They've found, like, a brain tumour.
There's a chance that I can make things a lot worse
if I'm not choosing the right patient at the right time.
We've got a finite amount of resource,
and a growing backlog of patients, and that's difficult.
My first patient is losing vision,
so she's going to be the priority patient.
We'll try and pull out all the stops
so that we don't have to cancel a patient on the day.
When you finish surgery and it's gone well, it's great.
I love that feeling.
How you doing? I'm alive.
It's OK? Yeah, it's all gone fine.
But we're happy, aren't we? Yeah.
All right, my darling. See you soon.
Yeah, champion.
Good morning, guys.
Room 15. Which is that way.
Everyone in surgery has challenges,
and I think you can split those into the conditions you're dealing with,
and then sort of the outside pressures,
the external pressures of the hospital.
Waiting list pressures, bed pressures.
Sheila Fraser is a leading endocrine surgeon.
She operates on a network of glands and organs
that control hormones around the body.
It is a small speciality,
and it's one that lots of people have never heard of.
We deal with both benign and cancerous thyroid conditions.
We also operate on thyroids if they're over-active,
if they've become too large. Ancl that can cause real problems
with people's breathing and swallowing.
Sheila shares an operating list with Emma Collins.
We want to give the patient the best outcome,
and sometimes that's better with two people, rather than one.
So, 68725.
People often think we're sisters, because we both have curly hair,
we both have glasses. Ancl it throws them every time. Yep.
THEY LAUGH
We can divide and conquer. I can do the team brief.
See that one?
She needs doing. That's been listed ages ago, and hasn't been done.
So, there was a lady we cancel led last week. Yes.
Ancl there's a gentleman that I saw last week
that definitely needs doing. So that's three cases. That's three.
I'll be operating Monday, Tuesday, Wednesday, Thursday.
It's just so many. It's trying to prioritise.
We are a small department.
At the end of the clay, there's only myself and Emma
as full-time consultants.
You work as hard as you can, and sometimes it feels like
you're not making any difference to your waiting list.
There's so many of these.
You feel guilty.
These poor patients are waiting and waiting, and you keep thinking,
"If that was me, my brother, my sister, or my mum, that's not fair."
One patient prioritised on today's surgery list
is 85-year-old widow Patricia.
Two months ago, she went to A&E with breathing difficulties,
and a large benign tumour was discovered on her thyroid.
You've been here...
OK. So I'll be in touch.
All right? All the best.
Just through there. Started off just a few months ago,
she was getting very breathless
just walking from one end of a bungalow to the other.
It's concerning because it obviously needs quite a major operation
for a lady of her age.
My breathing's appalling. I've got something growing in my throat.
It isn't cancer, but something's growing in my throat,
which has knocked the windpipe.
A lot of people who get referred to us have thyroid enlargement.
It's grown down into the chest, so it's growing behind the collarbone.
As it gets bigger, even if it's not cancer,
it can compress your windpipe.
And we've had patients where their windpipe has been narrowed to
a few millimetres, from a benign growth of their thyroid glands,
which, if you can't breathe, you can't survive.
So these can cause serious problems.
It frightens you. You never think about breathing,
do you, until you can't?
What I want to do is get back to normal
and be able to do my housework and enjoy my garden.
I love gardening. And you don't want to be dependent, do you?
You know, you want to paddle your own canoe, don't you?
SHE LAUGHS
Patricia? Hello, are you all right?
Nice to meet you. I'm one of the other consultants.
You get two for the price of one today. Come and have a seat.
If we do a case with two consultants,
and it's a difficult case,
actually, that will massively reduce our operating time.
I think for those difficult patients and big cases,
it's a massive help. Mmm.
So the plan today is to remove this left half of your thyroid gland.
It's pushing on things and causing problems. Yes, I know.
So we want to get you fixed today, all right?
And we're hoping we might be able to remove this
just with a cut through the neck. Will I be able to talk afterwards?
Well, that's the hope. We don't want to make you not talk,
but there is always a risk to your voice.
So there are some risks of the operation.
Because the voice box sits here, and the nerves that
control your voice sit under your thyroid gland, like this.
So the thyroid gland sits at the front of the neck.
The thing that we really worry about is the nerve to the vocal cords.
Because we have to peel the thyroid off it when we operate,
it can have a significant impact on their life if we do damage it.
There's about a 1 % chance of a permanent change,
which can affect the way you talk, the way you swallow.
But about 5% chance of a temporary change.
And to be honest, Patricia, in this operation,
when it is this big, the chance is probably a little bit higher.
Well, I can't go on like this, can I? No, exactly.
You need to get it fixed. Yeah.
She is a bit hoarse, actually. She wasn't when I met her in clinics.
Her voice is different to when I met her.
We could scope her this morning.
We've got time. Yeah, I wonder if we should scope her.
The team are concerned that Patricia's loss of voice
may indicate the large tumour on her thyroid has damaged the vocal cords,
which would make operating more risky.
There's things that we really worry about in the neck,
and the things that really concern me
is the nerve that goes to the vocal cords, controls the speaking,
but it also affects their swallowing.
It can affect their breathing. If I'm taking someone's thyroid out
when there's already one vocal cord not working,
and we damage the other one, we stop them breathing.
Another patient on Sheila and Emma's surgery list today
is 57-year-old Trevor.
He also has a large benign tumour on his thyroid
that needs to be removed.
Ancl what is it that you're allergic to?
A little bit nervous, wondering what's going to happen.
I'm struggling to eat, out of breath.
I think it's quite a nervous thing anyway,
coming into hospital for an operation.
They've been good so far. You've signed the consent form? Yes.
I think it's very frightening for patients, and also sometimes,
it isn't obvious, because the thyroids enlarge gradually.
If it's grown into the chest, rather than obviously in the neck,
people may not even be aware of it.
But they know that they're struggling to breathe,
they're struggling to function as much as they were.
Before they can operate on either patient, the team must confirm
a bed will be available for them to recover in after surgery.
They need to take into account factors such as, do patients
need a high-dependency bed? What ward will they be going to?
If they're elderly, if they're frail, they may need more support.
The bed situation feels like an ongoing nightmare, to be honest.
Ancl the worse thing we can do is cancel a patient on the clay,
but it does happen.
Trevor, although he's younger and looks fitter,
he's got more of a cardiac history, so he needs an HDU bed.
Ancl then our other lady, who will also need a ward,
but not to an HDU bed. Again, it just depends on the bed situation.
Morning.
Did they say there was one? Is that right? Yes. Brilliant.
So shall we get everything ready for the op?
Yeah, absolutely. Thank you.
Lately, we've been struggling more for normal ward beds
than we have for HDU.
I've been told we have an HDU bed.
A high-dependency bed has become available.
So he is in... 15.
Morning, Trevor.
So the team take Trevor into theatre first.
I've been told we've got a bed, we can go ahead.
Right, I'll see you soon. OK, then. All right, then.
Thank you very much. All the best. Thank you.
Drawn on his VP shunts.
I'm hoping my breathing is a lot better than
what it is at the moment.
I'm looking forward to going on long walks,
which I haven't been able to do.
Bigger show, please.
I think for him, left side is quite high.
That's good.
So that should clear that. In the depths.
Yeah, go for it.
So that's the left half of the thyroid gland.
He should feel a lot better.
He's got his neck back.
It's taken the team almost three hours to remove the tumour
from Trevor's neck.
The next priority is Patricia.
But before they can operate,
they need to examine her vocal cords for any damage to the nerves.
Can you open big and wide for me?
As soon as 14 goes home, move 7 into 14.
My hands itch if I'm not operating.
There hasn't been a clay where I've not wanted to come to work.
I love it.
Naved Alizai is one of the country's leading
paediatric liver consultants,
and is one of 11 surgeons in children's general surgery.
The role of a surgeon is to manage a surgical patient,
not trying to arrange a bed.
Ancl quite often, our major cases get delayed coming to theatre,
which is not ideal, because it puts more pressure on you.
Hello. Are you ready? Yeah.
Of the 329 children waiting for operations,
77 need specialist liver surgery.
The longest wait should be at the top,
so that we can use the list to its maximum efficiency.
OK.
How do you decide who needs to go first?
It's not easy to prioritise children.
You know, one child over another child.
We look at the condition they need the operation for.
We look at the complications they can suffer
if you don't do the operation.
There you go. Well done. Oh, brilliant.
Well, you've not got these characters yet, have you?
The next child on Naved's list is eight-year-old Ollie,
who has a serious liver condition.
Ollie's operation was first scheduled before the pandemic.
This will be the fifth attempt to have his surgery.
It started three... Well, maybe four years.
Unfortunately, he was not feeling so well,
and then he vomited lots of blood.
So we took him to A&E.
Ollie has a blockage in the blood supply to his liver.
If left untreated, it could be fatal.
Morning. You all right? Yeah. Ancl have you made all these?
Yeah, he's been building.
What's happening is, at the moment the blood is bypassing the liver
and when the blood is bypassing the liver, it's affecting other organs.
It affects the brain, if affects the lungs.
The blood flow, which has to go through the liver to filter,
to get filtered, cannot go through liver.
Liver can't filter the nutrients,
liver can't manufacture the products it has to.
Because the blood is bypassing the liver,
these toxic substances can go in the rest of the body.
It can cause serious bleeding.
People have died because of that bleeding.
They vomit blood, and they can die.
So it is a very serious condition.
During surgery, Naved will take a vein from Ollie's neck
to attach to his liver, to get around the blockage.
The operation is so difficult,
Naved is one of only two surgeons in the country who can perform it.
It's liver surgery, it's microsurgery.
A lot can go wrong.
You do one thing wrong, and it doesn't work.
Ancl not many people do it for that reason.
Does he or she have a name?
No, it's a he! It's Rodgy.
Rodgy. Aww, so Rodgy's coming.
He's got pictures. Do you want to show them?
Yes, please.
Oh, let me see. Who's that?
That's Mummy and Hazel.
Is that your sister? Yeah.
Waiting for this operation has been dreadful, to be honest.
I think this is the fifth attempt.
You get hopes of it happening, and then it gets cancel led again,
and it got cancel led in November...
...last year, and we didn't find out till two o'clock the day before,
and it was just heartbreaking.
It's not uncommon for us to cancel a patient.
Ancl it's not a nice discussion when we go and tell them.
But most parents are very sensible, they understand.
We do try not to cancel if there's any space anywhere.
Ollie is just the most lovable, caring boy. He...
It's going to make me emotional, but...
He's just gorgeous in every way.
We just hope that it goes well, because it's such a big op.
Also on Naved's surgery list is one-year-old Maya-Mae.
She was born with a large cyst
growing in one of the ducts to her liver.
The cyst is life-threatening, and needs to be removed.
I'm very, very nervous... for the whole procedure.
You just want nothing but the best for your kid.
Especially with your first child -
you have that new mum worry already, anyway.
And then for this to be added on top...
This last year has actually been nothing but stress and worry.
It's a little girl who was born with a problem with the liver.
It's a condition known as choledochal anomaly.
It is a serious condition.
Because if you don't remove it, in the long run,
it can change into cancer.
She's eating a lot of solid food now,
so she's literally screaming in pain, trying to push it out.
Ancl I just don't want her to keep going through that.
This dark bit is the liver, and this is the cyst.
It can cause blockage, and it can cause pain,
infection, stone formation, and various other things.
So the plan is to remove this white bit completely.
Naved is the only specialist in the hospital
with skills in robotic keyhole surgery
who can perform Maya-Mae's operation.
This patient was unfortunately cancel led last week as well,
so we want to bring them today and check them for Covid.
Ancl hopefully it'll get clone.
PHONE RINGS
I've got a patient, she was booked in 50, but 50 is full.
As Maya-Mae lives 40 miles from the hospital,
Naved needs to find her a bed for the night before her surgery.
What is the bed situation at the moment with you?
Without a bed, her operation could be cancel led for the second time.
There is no bed in 50. 42, it doesn't look good.
Could you please let me know what the plan is?
Because ideally, really I don't want to cancel this patient again.
We have a long waiting list, and patients, they need surgery.
PHONE RINGS
I'm just ringing you because we're struggling to get this patient in.
All right, OK.
Yeah. I guess that could be an option. I'll discuss with Jo.
Many of our patients travel very long distances for surgery.
They have to come the clay before.
If they come a clay before, that is an extra bed clay,
and because we're always short of beds,
so we started to put families up in the hotels.
Just off the phone to Naved. Yes.
Just to see whether there's an option
we could put in a hotel tonight. Is it Maya? Yes, Maya.
We can book her a hotel if that's good.
That's fine. Lovely.
Hello.
Hi, is that Maya-Mae? It is, yeah. Hi, I'm Mr Alizai.
Hello. How are you?
So you've got a hotel? Yeah.
OK. You're happy to sign the consent form? Yeah.
That's fine. So I'll come and see you in the morning.
That's your copy. Thank you. See you. Bye-bye.
Thank you very much. You're welcome. Bye. Bye.
Prior to any operation, all patients are tested for Covid
before their surgery can go ahead.
He has been really fighting for us.
I am really grateful for him running round, because obviously,
it's down to him why we're here today.
Because he's told them, "No, it needs to be clone this week."
So I am really grateful for that.
PHONE RINGS
Hello, you're through to the Elective Orthopaedic Ward
at Chapel Allerton. How can I help?
When I first went into an orthopaedic theatre,
I almost knew immediately that's what I wanted to do.
Unlike a lot of other specialities, it's very, very visual,
so if you see my joint replacement, you can see what I've clone,
it's there. There's no hiding.
Joe Aderinto is one of 15 orthopaedic surgeons
that operate on adults at Chapel Allerton Hospital.
Waiting lists for orthopaedic surgery
are one of the longest in the trust.
Deborah's in room two. Right, she's being seen at the moment, is she?
Um, Mindy's in there with notes.
Ancl Anna has just gone into side room six.
OK. All right? OK.
With no emergency department and only pre-planned operations
at Chapel Allerton, cancellations are kept to a minimum.
We've got four consultants, four registrars,
four anaesthetists, and four theatres.
We've got a full team in every theatre.
Before the pandemic started,
we used to do between 25 and 27 operations a clay.
Since we started operating again, we are finally,
from starting from seven, creeping back up to...
Today we've got 15, have we, Lynn?
On his list today, joe has operations
for damaged hips and knees.
On the clay of surgery, we tend to prioritise the cases.
So cases which are more complex or are going to take longer to do,
I prefer to do them in the morning.
But surgery can be unpredictable,
and it can take longer than expected.
I'd like somebody to putjune into room six, please.
She's with her husband. He just wants to see her off.
If you follow me down, and we'll say goodbyes down there.
Thank you. You're welcome.
One patient on Joe's list is 79-year-old June,
who has come in for a scheduled hip replacement.
There you go. Come in here.
June has had physiotherapy for the last four years.
But recently, her mobility has deteriorated,
and she now needs surgery.
When I see patients who have severe pain
struggling to enjoy their lives, I feel it's my responsibility
to get them to operating theatre as soon as I possibly can.
I can't walk round a supermarket, or anything like that.
If I do anything in the house,
I have to sit down every five minutes to have a rest.
I haven't actually slept in bed, I would say, for six months.
We have a recliner chair, and I've had to sleep on that.
One of the complicating factors is she had a nail in her femur...
...that was used to fix a fracture when she was 23.
So it's been in for more than 50 years.
So that had to be removed first of all,
before doing the hip replacement.
I'm hoping to do both in the same sitting today.
Providing we can remove the nail.
To make space forjune's new hip,
joe needs to remove part of her thighbone.
But to do this, he must first extract the 50-year-old metal pin.
Right... Are you going to go now, before the traffic gets busy?
Yes, I will.
Have a nice day. Oh, yes, I will, I'm sure.
We'll look after her! LAUGHTER
Next year, it's our diamond wedding.
So we're hoping to be OK for that, to celebrate.
Hopefully.
When you get into your 80s,
you need to do as much as you can, don't you?
Give it some welly. SHE LAUGHS
Hi there. How are you?
I'm a bit apprehensive, but I'm OK.
So, as you know, we're planning on removing that nail from your femur.
Yeah. Ancl then doing the hip replacement after.
There is a small risk we may not be able to remove that nail.
It's been in for more than 50 years, hasn't it?
I'm just a bit worried. If you can't get it out, what's going to happen?
Well, we'll try our best to get it out. I know, I know.
As I say, I've put my trust in you, and I hope you do.
OK, I'll see you soon. Yeah, see you soon. Thank you.
Once June has been operated on,
next on the list will be 83-year-old Dermot.
He needs surgery for a knee replacement.
I should have had it done on the 18th February.
But then I had an accident. I fell over...
...picking the dog up from the groomers.
So then I had to cancel this.
It's just painful, so painful all the time, you know?
It's not good. Ruins your life, really.
If the phone starts ringing, which will be any time now,
we will then be prepared to take the first ones through.
If we do have full operating lists, then it is our responsibility,
both mine and the team, to make sure
that we get everything completed in that clay.
We don't have to cancel patients often.
It does occur, and the usual reason is an overrun.
I think the more complex cases probably cause the more stress,
if you want to call it that,
because you're going to almost the unknown, to a degree.
If you look at this X-ray here, this nail is, as I said,
more than 50 years old.
Sometimes they come out fairly easily.
Sometimes, because they've been in for such a long time,
they can be almost incarcerated and difficult to remove.
In order to get through the whole list, I really want to have...
or ideally finish this operation
within the next two and a half hours.
First, joe needs to remove the 50-year-old pin from June's thigh
before he can insert the replacement hip.
The team wear special operating suits to prevent
contamination of the metal implant.
I can sort of see the top of the nail here.
It's covered in some bone, which we're just removing just now.
Problem is getting to grip it, at the top.
I need to grip it with something. It needs a mole grip.
As the pin has been in June's leg for decades,
the bone has grown around it, making it hard to remove.
HE BLOWS HIS LIPS
Hitting it really hard. It might fracture the hip.
I don't want to force it into that femoral.
Removing the pin from June's thigh is proving very difficult,
and the operation is going to take longer
than the two and a half hours that's been scheduled.
So, who else do we have?
Hi there, my name's Pam.
I'm calling from the surgical endocrine team at Stjames's.
Patricia? Can I get you to come through a minute? Is that all right?
It's never-ending!
85-year-old Patricia is hoping to have a large tumour
removed from her thyroid.
But endocrine surgeon Sheila is concerned that the nerve
on Patricia's vocal cord may be damaged.
This would mean the risks from operating could be more serious
than just the loss of her voice.
Your vocal cords do this, and this is how you talk,
this is how you breathe.
If one of them doesn't work, it does that.
So you're moving one, and you can normally talk,
you can normally breathe. If two of them don't work,
they do that, and then you can't breathe.
So we always want to know if somebody's nerves
aren't working beforehand, because it's a lot higher stakes operating.
When we saw her this morning, her voice just sounded quite breathy
and a lot quieter than when I originally met her in clinic.
So what we're concerned about is, is this resting on a nerve,
has there been any stretching, any changes to the nerve,
any worries about it?
So what we can do is put a little camera down
and look at the vocal cords and watch their movement.
I just want to check the vocal cords are moving properly.
Now to do that, we actually put a tiny little camera,
and we put it in the front of the nose.
And the reason we put it through the nose is
because then actually from the back of the nose,
we can almost look straight down on to the vocal cords.
It does sound, even from when I met you in clinic,
that your voice has got a lot quieter.
Yes, it is. There's no power there. No.
So this is the little camera - it looks a lot worse than it is.
So look straight ahead for me, Patricia.
If one nerve is already damaged, there's a risk today's surgery
could affect the remaining nerve,
which may stop Patricia being able to breathe.
So I'm coming up to your vocal cords now.
Oh! Have you had any problems with your nose before, Patricia?
No, none. Right, now "Ah". Ah.
SHE COUGHS
OK, they're both actually moving fine.
I can see them moving nicely,
and they're both moving as they should be, OK?
So that's reassuring.
Patricia's vocal cords are moving normally,
which shows the nerve is not damaged,
so the operation can go ahead.
You are next. Well, you've made my clay, if I'm next.
But Sheila also has concerns about the size of Patricia's tumour.
The reason Mr Milton is here
is because Patricia might need thoracic intervention.
She's asked thoracic surgeon Richard Milton
to attend the operation.
If they are unable to remove the thyroid through a cut in her neck,
Richard will have to open Patricia's chest.
Opening the chest on an elderly patient
definitely impacts their recovery time.
It makes it a much bigger operation, because to open the chest,
you actually have to break the breastbone, the sternum.
That can be quite an insult to an elderly patient,
and inevitably it will take them longer to recover
than if we can remove the thyroid through a cut in the neck.
You're going to have an incision in your neck.
We won't know until the start of the operation
whether we need to open your breastbone -
it just joins it like a letter T. That's all right, I know.
But we won't wake you up and ask you. No. All right? No, don't. OK.
We'll take really good care of you, all right? I know you will.
We will. I know.
Once in theatre, the team start the intricate work of trying to
remove the tumour through a cut in Patricia's neck.
Can you see down here? There's quite a big vessel.
Oh, that one. That one.
Which I'd rather not hit.
We get sent quite a lot of the really big thyroids.
Now, a lot of the time, if we make a cut in the neck,
we can still actually bring them out of the neck.
But there's still a significant number that we see
which have grown so large, and have gone into the chest,
that we cannot actually access without opening the chest.
We would only do it if we genuinely can't get it out through the neck.
If we don't have to open her chest, it's better for her.
Anything we can do.
I think we're going to struggle, personally, through the neck.
Let's just reach it and see if there's any more we can do.
Emma, any check? No, I think you're going to struggle,
because anatomy-wise you can't see anything.
We're going to open the chest.
BONE SAW WHIRS
Are you worried you might crack it? Yeah.
Now Patricia has been cut open,
Sheila's next challenge is to locate the nerve to her vocal cord.
It's critical the team don't damage it when removing the tumour.
It's one of the things that we always worry about,
so we will spend a lot of time trying to find that nerve.
So trachea is there.
So nerve could be anywhere in that bit.
We have a nerve monitor, which gives us feedback.
So it makes a particular signal if we're on the nerve.
So we should get a signal,
and if we don't, it's something that we've clone, or we haven't found it.
Try that bit there.
It reduces our stress when we find that nerve.
MONITOR SOUNDS Yes! Yay!
That's the nerve, we're happy.
I'm always stressed until I've seen the nerve, always.
With the nerve to the vocal cord located and intact...
Right, shall we crack on? Let's do it.
...Sheila must now carefully extract the large tumour
from Patricia's thyroid.
Because this was so big, that trachea,
instead of being in the mid-line, was pushed right across onto
the right-hand side, and that was affecting her breathing.
Forceps, please.
Left thyroid load. Scissors, please.
I would say every operation we do,
there are one or two bits which will always cause you a bit more stress
until you've dealt with it, and then you can feel yourself relax. Yeah.
Ancl actually you can feel your whole demeanour in theatre change. Yeah.
Are you all right, Patricia?
At Chapel Allerton, joe is already two hours into his planned
two and a half hour operation...
It's not going to move much, is it?
...but he's still struggling to remove the pin
from 79-year-old June's thigh before fitting her hip replacement.
I'm going to try this hook device, to go into a hole in the nail there.
Can you hold it there? Thanks.
We don't have many more options than this,
to be honest with you, if this doesn't work.
Removing metalwork from a limb can be difficult sometimes.
The amount of time it's been in can be a factor.
It might not be straightforward.
When you do face that difficulty, the important thing is to
essentially remain focused and try and execute the plan.
Hmm.
Oh, it's coming out, I think. It's definitely moving, I can feel it.
June's bone has calcified around the 50-year-old metal pin,
making it hard to remove.
HE EXHALES
The longer it takes, the greater the delay for Dermot,
who is due in theatre next.
It'll be about another half an hour, Dermot, love, OK?
It's... The case is complicated that's on the table.
Well, there's someone worse than me, probably.
This is what I hate, needles.
I live alone, just me and the dog.
And he's in the kennels at the moment.
So I'm hoping to be able to go for a nice long walk.
Joe has managed to uncover a small part of the pin,
but the rest is still firmly lodged in June's thigh.
Yeah, it's out more than that, look. That's more like 20 now.
Try again?
It's just very, very slow, so... It's coming out.
Having made some progress, joe decides to persevere,
but now he will have to cancel his next patient.
I don't want to have to give up yet.
I think I'm going to try and get this out.
I'll keep on going.
Afternoon. How we doing, you OK?
Unfortunately I'm having to bring you some bad news today.
We're having to cancel the case.
Mr Aderinto has run into some difficulty in the case that
he's in theatre with at the moment.
It's taking a lot longer than was anticipated.
So there's not going to be anybody else going into theatre today.
I've had a conversation with the teams upstairs,
and we can get you back in on 12th May.
So that'll be next Thursday. You'll be first on the list,
so you wouldn't have the wait that you've had today.
0|<. OK? Yeah. All right.
I'm really sorry, and I'll get the guys to bring you a drink.
OK. Thank you. Thanks.
We don't cancel cases often,
but sometimes, during a list, it becomes clear,
because things are taking longer than expected,
you have to make a decision to cancel a patient
towards the end of the list,
because you know you're going to run out of time.
Hiya, john. PHONE: Hiya.
The 0perati0n's been cancel led.
I know.
So can you pick me up?
OK.
All right, john, bye.
Joe has now been in theatre with June for more than four hours...
My hands are blistered now.
I can't do anything any more, if I wanted to.
...but the pin is still stuck.
He's called in colleagues to see if they can help.
I can't hit anything more, really.
Can you keep hitting it?
I'll keep hitting it, I'll promise.
You just have to make a decision as to how long you're going to
continue trying to resolve the problem,
when to call colleagues to help - or even when to stop.
There does come a time where one has to stop.
Maybe now we need to look at accepting that we can't get it out.
I can cut it, if you want.
Thanks for your help. We tried. INDISTINCT
Yeah, I will do, I will do.
We can't remove it,
so we're going to just cut it flush with the bone,
or just above the bone,
and then we'll wash out the wound and close up.
After five hours in theatre,
joe has been unable to remove the pin from June's thigh,
and so calls time on the operation.
We tried.
It's not something that happens every often,
but when it does, it's pretty awful for the patient,
and it's just one of the things you just have to accept can happen,
and sometimes things just don't go to plan.
We were aware that it could be difficult to remove.
We did get some of it out, but we just couldn't get it all out.
So at some point, you just have to make that decision to stop.
It's the end of the shift, and liver consultant Naved
has discovered a complication with one of his patients, Maya-Mae.
PHONE: Hello? Hi, is that Maya-Mae's mum?
Yeah, it is, yeah.
Hi, it's Mr Alizai speaking. Hiya. Hi, have you arrived in the hotel?
No, still waiting for the taxi outside.
Are you? OK. Can I come and see you, yeah?
Today? Now, yes.
Yeah. OK, just wait. If the taxi comes, ask him to wait a bit, yeah?
Do you want to come in for two minutes? Yeah.
I'll push... Yeah.
Maya's Covid test is positive.
Positive?
You're joking!
I'm sorry.
CRYING: We've literally been at home for ten clays,
so I don't know how this has happened.
It's so common, it's just so common.
We can't take the chance.
I'm sorry.
Stressful, but...what can you do?
Maya-Mae must now return home,
and the operation will be rescheduled
once she tests negative.
Today, after four cancellations,
Ollie will finally be having his surgery
to correct the blocked vein into his liver.
This operation is going to take many hours, most of the clay.
May go into the evening as well.
Naved will use a vein from Ollie's neck to create a hollow tube,
known as a shunt, to bypass the blockage.
It's a very, very tricky operation.
When I learned it from the surgeon who taught me,
I wrote a very long note, dos and don'ts.
I still have that, I read that every time before I operate,
even though I've been operating for the last 30 years.
Sweet dreams.
That's it, there we go.
It's a major responsibility
when a parent brings their child towards theatre.
When I saw parents cry,
that puts a lot of pressure on everyone.
Ready, steady...
Once we start, then we just switch off from everything else.
I think this is maybe enough. Is this ten?
Ten mils out.
This is part of the liver we're going to dissect first.
That's going to lead us to the blood vessel
where we want to do the shunt.
The operation could take around ten hours.
Naved must take the vein from Ollie's neck,
which he will use to make the shunt.
This will replace the blocked blood vessel into Ollie's liver.
This is a very tricky operation, very high risk of complications.
When we take that vein,
we go all the way to the base of the skull,
and if you lose control at that point,
you can have bleeding inside the skull.
We will now go to the neck, and do the dissection in the neck.
This is the second stage of the procedure.
So that's the vein.
We have to be very careful that we don't break the vein
or cause any bleeding in that area.
Er, just...
It's too noisy now. Can we just keep quiet, please? Thank you.
Everyone...
...if you lose this, it's going to go and bleed in the chest.
It's hard.
For 11 years, I was a nurse,
so I know what goes on behind closed doors in theatre,
which makes it worse because
my mind can't switch off from what's going on.
So it's almost worse to know too much.
Suction, please.
Suction.
MAN: This is the vein coming out.
The next stage of the operation is the most critical,
as Naved creates the shunt by carefully attaching
the vein taken from Ollie's neck to bypass the blockage to his liver.
One wrong turn can cause a major, major issue.
When I'm tackling an area where things can go wrong very easily
and quickly, my full concentration is there.
Even if someone punches me,
I won't feel it.
That is because, if anything goes wrong at that point,
it can be catastrophic.
If it doesn't flow, it's too tight.
Hi, is this Oliver's clad?
I'm just ringing to let you know that we'll be a few more hours.
Ollie has now been in theatre for more than eight hours.
Really missing him. We can't wait to see him and...
...find out how it's all gone, and...
We've had some updates, so they've both been positive.
So fingers crossed there's no complications
and he is back with us in a couple of hours.
It's a very big operation, and the only time you find out
whether it's working or not is right at the end.
Ten hours down the line, if it's not working,
it's very upsetting for the surgeon and obviously for child and parents.
The success of the operation will depend on
whether blood begins to flow through the shunt and into the liver.
Alll do is pray,
just hoping that we see good blood flow.
Bleeding coming from the liver side, it's pulsating.
I can see the flow, so that's good.
Yeah, that feels good. That's good.
OK, we're ready to close, thank you.
Yes, I'm quite happy that it's OK.
We've clone everything that we could have, and it's working,
so...|'m happy-
It's gone 9pm, and after ten hours, Ollie's surgery is complete.
Hello, hi.
We're happy it went fine.
We've clone what we wanted to do. MUM: Excellent.
Ancl at the end, it was working, you could see it. Was it?
You could see the flow through the shunt.
We got there. Oh, thank you so much for everything.
The most amazing feeling for me
is that after doing a major operation, I go to parent,
and I say, "Everything went fine."
Ancl I sometimes get tears in my own eyes.
All of those things could have gone wrong, but they didn't.
The child is well, they'll wake up in a few minutes
and they'll come and see you. Sorry.
It's a long procedure, so he will be a little bit grotty.
Oh, thank you so much.
Thanks.
Over the next week, Ollie will be closely monitored
to check his blood is flowing freely through the shunt.
It's one of the doctors speaking, how can I help?
At Chapel Allerton, Joe has come to visit his patientjune,
after they were unable to complete her hip replacement surgery.
Hi. How are you feeling?
OK, thank you. OK.
So, we couldn't get the nail out yesterday. I know, I know.
So we spent several hours, actually, trying to remove it. I know.
Five, I think, wasn't it, something like that?
Yeah, but we couldn't get it out. Yeah.
I think what we'll do is we'll get you up and mobilising,
and I'll bring you back to see in my clinic in six to eight weeks...
Yes. ..and we'll have a chat then. Have a chat then.
We'll see what your mobility's like and make a decision what to do.
If we were to have another attempt and do a hip replacement,
it would be quite a large magnitude of surgery. Yeah.
But we'll discuss it. We'll just have to see how it goes, won't we?
Yeah, we'll see how it goes, yeah. OK? OK.
Good, so I'll see you tomorrow. Thank you. OK, bye. Yeah, thank you.
A second attempt at a hip replacement would involve
much more invasive surgery to remove the pin,
and a longer recovery time forjune.
I just had to tell her the bad news that we couldn't remove the nail.
We would have liked to have removed it.
But I think that sometimes you have to, you know, admit defeat.
So, we removed as much as we could.
I did discuss the options with her briefly, so she's going to
have to think about that before making a decision.
My name's Anne Marie. I'm one of the doctors.
I'm just going to put a little bit of jelly on your tummy,
and have a look, all right? I'll be really gentle.
It's been over a week since Ollie's surgery
and he's being closely monitored to check that blood
is still passing through the shunt and into his liver.
Sometimes, you know, you spend all clay, all night here, just waiting
for the scans, to make sure things are right at the end of the clay.
But a number of scans show there is a problem.
His flow through the shunt is reducing, and the scan
has suggested that one of the ends of the shunt looks quite narrow.
Hello, hi. OK. Hello, Oliver.
You OK to talk? Yes. OK.
So, I've had a look at the scan.
The upper end does look very tight.
Ancl I think we can improve it
and I think we should take Oliver back to theatre. Right.
Now, it's not going to be an easy operation,
but we'll be careful, and we'll see.
Because my worry is that if we don't do it, it's going to block.
That's the main reason I want to do it. Sorry.
I think it's quite critical,
because the way velocity is going down in the shunt
means that if I don't do it, it will stop working.
Ancl a clot, a thrombus, will form in the shunt.
We knew from the offset when we were explained about the op
that he may need to go back in.
Ollie will need to have the emergency surgery
within the next 48 hours.
It is a worry.
It's constant, really. I mean, you don't...
You don't get to sleep cos you're stressed, and, you know,
our daughter, as well, not all being together.
It is really hard.
What we doing when you get home?
Party!
By the sounds of it, we're having hot dogs, aren't we?
Hot dogs and ketchup.
Fingers crossed this one works.
So we'll have a look at the queue list.
Naved needs to find out if there is room to carry out
Ollie's surgery on the emergency theatre list.
Fine.
So, no new patients? Unless they haven't been booked?
There's a line insertion that's not in... OK.
There hasn't been any additional patient
who needs to go on the emergency list,
which means that we're going to do Ollie.
As Ollie's emergency surgery gets under way,
Naved starts to investigate.
I would have been worried if I had decided not to do anything
because that's where you're taking a big chance.
Is that a clot or...?
I can't feel a clot, it's compressing very nicely.
I want her to tell me whether there is flow in the shunt,
or if there is a blockage.
Wondering where should I open it.
Open it there, that's too far, we won't be able to see clearly...
You can see quite a bit below, I think.
...because something here.
Er...
So, I'll open it.
As Naved opens up the shunt, he finds one end has narrowed.
So that's the shunt, this one, blue.
So that's where the narrowing is.
I'm going to take this off, and I'll cut it open there
and I'll make this joint between these two wider.
It is wider, definitely.
It was three millimetres on the scans.
Maybe twice as wide, or maybe slightly less than twice as wide.
I don't know, maybe.
They test the blood flow through the newly-widened shunt.
That's good flow, that's nice flow.
There's flow and you can't see a thrombus.
Because that was full of thrombus before, and now it's not.
Yeah, thank you very much, thank you, thank you.
We managed to enlarge the joint between the shunt and the liver.
So that's bigger.
So I'm just hoping that it stays like that.
Um, and let's see what happens.
Morning. Morning.
This lady is in 25.
The endocrine team check on 85-year-old Patricia
after her chest was cut open
to remove a large tumour from her thyroid.
Good morning!
Hello, how are you?
Bit mixed up, really.
A bit mixed up? Yeah, I'm not surprised.
It's quite a big operation, isn't it? Yeah.
We didn't really have any other way of getting it out. No.
So we did have to ask Mr Milton to step in.
He had a shovel, did he?
Pretty much, yes.
Bit of a saw.
But you got it out? We got it all out, yeah.
Does it feel any different? I can breathe deeper, but it hurts.
You're going to be sore, just for a few weeks.
It's like a broken bone, isn't it? Yes. So it's got to heal.
Opening the chest on an elderly patient
definitely impacts their recovery time.
We always worry we'd cause more harm than good.
Can I have a little look at you, see how you're doing?
Big breaths for me, Patricia.
Ancl in...
All right, last two. just a minute.
That's all right, take your time.
Well clone.
I really need you taking big breaths, because I don't want you
getting things like a chest infection.
So it's really important to take big breaths for me.
I will try my best, if I can sit down.
Yeah, so that's the most important thing.
I will, I promise. And we'll try and get you home in the next clay or two.
That's something to look forward to, you know what I mean?
See you in a bit.
She's so sweet.
She's sitting up, she's got into the chair, she's eating, she's drinking.
She's got a bit of pain. She's older, she's in her eighties.
Quite frail, so it will hit her harder.
Maye-Mae is now free from Covid,
and has returned to hospital with her mum, Bethany.
Today, she will have her rescheduled operation
to remove a cyst from her liver.
I thought we was going to be in a hotel again, but to be here
in the hospital now, it kind of feels, you know...
It feels like we're definitely more on the tracks for it
definitely being clone this time.
This is the liver, and that's the cyst we are going to remove.
Looking forward to doing Maya-Mae finally,
because she's been cancel led twice over the last few weeks.
We have to fight in so many corners
just to get that patient on the table.
So we'll take really good care of her,
and we'll see you later on, OK?
That's fine.
SHE SNIFFLES AND SIGHS
OK, bring the robot in, please.
So, I'm going to set in the robot and start to operate now.
When we operate on children, the tissues are very small.
When we do robotic surgery,
we can take the camera very close to it,
and everything gets enlarged.
So even if you're working on tissues which are 2mm, 3mm,
we can do the procedure safely.
It has more degree of movement than a wrist.
It is as if I'm sitting IN the patient and operating.
Ancl that's still the cyst, OK.
It's much bigger than what was on the scan
because the scan was clone a long time ago.
Been a bit of an emotional wreck, to be honest.
Can't help your mind doing overtime.
It's the worst thing about it, being a parent in this situation,
putting your child's life and safety into somebody else's hands.
It's just, it's nerve-racking, it really is.
So, got the last few stitches.
I'll take one more, and then take another stitch after that.
So that's fine, I'm happy with that.
Ancl the operation is finished.
Hi, my darling!
After more than four hours of robotic surgery,
the cyst is finally removed.
In just over 48 hours, Patricia has made good progress,
and her voice is getting stronger.
I woke up this morning and I felt me again.
Yes, I did.
And I'm grateful for that. Very, very grateful.
I shall be always be grateful to this place.
I shall pass it time and time again, and I'll send it a kiss.
Take care, then.
All the best, all right? Yeah, and to you.
When you see somebody where you've dramatically changed their life,
and they are grateful to you, that is the best reward you can ever get.
We can have really stressful clays and sometimes you get to the end
of a stressful clay and you think, "Why am I doing this job?"
Yeah. "What am I here for?"
But then, if you see the patient afterwards,
and then you see them go home, and you see them back to clinic,
and you see the difference it makes, It actually makes it all worthwhile.
Ancl you think, "I would do that again."
Three weeks after Ollie's first operation,
Naved has good news for the family.
Hello, how are you?
So that scan that we did yesterday,
I'm quite pleased to see that it's good flow.
So, um, what do you feel about going home?
FAINTLY: I feel excited.
Ancl you're giving your sister a big cuddle, aren't you?
You've been missing her. You haven't seen her for weeks.
I'm happy to see you go home today.
Thank you. See you, bye.
It is good to see that he's recovered fully.
Ancl that's an operation I really, really love.
It's a difficult one, but when it works, it works very well.
He's been here at 7am every clay, pretty much, he's been in work.
He comes in to say hello in the morning, have an update
and if he doesn't finish too late, he's been in in the evenings.
He's... I, I'm not sure he has a home!
HE CHUCKLES
Ready?
Ready to go and see your sister? Yeah! Yeah!
When we get good outcomes,
when we can go and tell a parent...
...that it's all sorted,
it's a good feeling.
Thanks, everyone.
I'm sure people who work with other specialities,
they get the same kind of buzz.
OLLIE WHOOPS But this is what I get,
just because I work with children.
Awww!
Oh.
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